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Evaluation of the Uterus and Fallopian Tubes
Ultrasound
Ultrasound is one of the most important tools in evaluating the infertile patient. It functions by emitting sound waves that are either absorbed or reflected based upon the structure and composition of the target organs. These reflected sound waves produce images similar to those produced with x-ray but no radiation is required.
The vaginal probe ultrasound is used extensively during infertility treatment,
especially if the patient undergoes ovulation induction with fertility drugs for IVF or stimulated IUI. The ultrasound allows visualization of the follicles as they develop and the physician can closely monitor response to medications.
The lining of the uterus must develop to the proper size to accept the developing embryo and the ultrasound is used to measure its thickness. Internal organs such as the uterus and the ovaries can be seen and oftentimes, uterine masses, such as fibroids are visible.
Hysterosalpingogram
 In the hysterosalpingogram, radio opaque dye is injected into the tubes and its passage to the uterus is observed via x-ray examination. It there is an obstruction; the dye will flow to the point of blockage and stop which is clearly visible on x-ray. Once the egg is released from the follicle it must travel unimpeded to the end of the fallopian tube following the same path as the dye. Blockage of the dye is indicative of the inability of the eggs to pass through the tubes. Some deformities in the uterus can also be observed using the hysterosalpingogram. These include fibroids, polyps, adhesions, a bicornuate uterus, or other congenital structural abnormalities.
The hysterosalpingogram is performed as an outpatient and is associated with minimal discomfort.
Hysterosonogram
The hysterosonogram allows the physician to clearly visualize the inside of the uterus using ultrasound. The uterus is first expanded with saline solution administered through a small "tube" inserted through the vagina and cervix. Next, the vaginal probe ultrasound is inserted through the vagina, the cervix and into the uterus. Expansion of the uterus with saline increases visibility making it easier to see/diagnose uterine disorders such as fibroids and polyps. Appointments for the hysterosonogram are scheduled so that the patient is not menstruating at the time of the test.
Hysteroscopy
The hysteroscope permits a more detailed analysis of the uterus than the hysterosalpingogram. In the hysteroscopic procedure, a small fiber optic "tube" is placed inside the uterus and the uterus is expanded with gas making the lining more visible to the physician. Abnormalities in the uterus including polyps or fibroids can be seen with the hysteroscope.
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